Provider Demographics
NPI:1093231797
Name:SWENSON, MELISSA RENE (DPT)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:RENE
Last Name:SWENSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:MORENO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3922 WISEMAN BLVD
Mailing Address - Street 2:BLDG V SUITE 502
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251
Mailing Address - Country:US
Mailing Address - Phone:210-775-6655
Mailing Address - Fax:210-761-7291
Practice Address - Street 1:3922 WISEMAN BLVD
Practice Address - Street 2:BLDG V SUITE 502
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251
Practice Address - Country:US
Practice Address - Phone:210-775-6655
Practice Address - Fax:210-761-7291
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1293965225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist